Plant thorn synovitis: An uncommon cause of monoarthritis (2022)

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Seminars in Arthritis and Rheumatism

Volume 21, Issue 1,

August 1991

, Pages 40-46

Abstract

Plant thorn synovitis (PTS) is an uncommon cause of monoarthritis. Seven cases of PTS were identified at our institution from January 1979 to July 1990, six of whom were men. Mean age was 27 years (range, 7 to 56 years). Symptoms included pain, swelling, and stiffness. Synovitis was present on examination along with decreased range of motion of affected joints in all patients. Roentgenograms were unremarkable in five patients, but disclosed demineralization in two others. Initial conservative treatment with nonsteroidal antiinflammatory drugs (NSAIDs), antibiotics, or splinting was usually unsuccessful; surgery was necessary in six patients. Findings included marked inflammatory synovial reactions with evidence of retained thorn in all patients. One patient had a positive operative wound culture (Enterobacter agglomerans) without evidence of osteomyelitis. All patients improved after surgery without sequelae. Despite a history suggesting thorn injury in many cases, diagnosis was often delayed; mean time to diagnosis was 10 weeks (range, 2 weeks to 9 months). PTS must be included in the differential diagnosis of monoarthritis. Histologically, PTS can mimic sarcoidosis, tuberculosis, or fungal infection. Optimal treatment of PTS is arthrotomy, foreign body removal, and extensive synovectomy.

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    J Bone Joint Surg

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    Arthritis Rheum

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  • N Cahill et al.

    Palm thorn synovitis

    J Pediatr Orthop

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  • M Carandell et al.

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    J Rheumatol

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  • RD Gerle

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    Br J Radiol

    (1971)

There are more references available in the full text version of this article.

Cited by (24)

  • Plant thorn synovitis of elbow in children

    2014, Journal of Clinical Orthopaedics and Trauma

    Retained thorn leads to foreign body reaction leading to hypertrophic synovitis, histopathologically it is a chronic granulomatous synovitis with foreign body giant cells.1,2 Elbow is an uncommon site for thorn induced synovitis and only few cases have been reported in literature.3–5 We describe four rare cases of plant thorn synovitis of elbow in children, which were misdiagnosed as partially treated septic arthritis of elbow or Juvenile inflammatory arthritis (JIA).

    Four rare cases of plant thorn synovitis of left elbow were admitted at our institution, which were initially misdiagnosed as partially treated septic arthritis of elbow or Juvenile inflammatory arthritis. All of them were of paediatric age group. Symptoms included pain, swelling, and decreased range of motion of affected joint. On examination synovitis was present in all patients.

    Roentgenograms & Ultrasonography were inconclusive in all patients, Definitive diagnosis was made only after arthrotomy, Thorn fragments (Acacia arabica) were recovered from the hypertrophied synovium & subtotal synovectomy was done and sent for histopathological examination. All patients improved after surgery with mean residual flexion deformity of 12.5±2.86°. Plant thorn induced synovitis of elbow is rare, it must be included in the differential diagnosis of monoarthritis of elbow and a high index of suspicion is needed for retained thorn fragments in elbow joint causing synovitis. Its optimal treatment is arthrotomy, foreign body removal and total/subtotal synovectomy.

    (Video) Plant thorn arthritis - Medical Definition and Pronunciation
  • Brodie's abscess of medial distal femoral condyle after a thorn prick: rare clinical presentation

    2012, Chinese Journal of Traumatology - English Edition

    Thorn prick injuries are generally conceded frivolous and rarely demand medical attention. How-beit deep seated injuries are well described in the literature. We presented a case of thorn prick injury to the knee that manifested as Brodie’s abscess of the medial distal femoral condyle and synovitis. Magnetic resonance imaging (MRI) and ultrasonography could only construe the affliction but not spot the thorn. Arthrotomy was undertaken for exploration and debridement. Empirical therapy with initial systemic Cefotaxime and subsequent Ofloxacin worked well after the surgery. Deep seated injuries by a thorn prick may take a protracted and torpid course. Thorough curettage of the bony lesion and debridement are vital for proper management.

  • Retained Hawthorn Fragment in a Child's Foot Complicated by Infection: Diagnosis and Excision Aided by Localization with Ultrasound

    2010, Journal of Foot and Ankle Surgery

    Candida parapsilosis has also been cultured from rose thorn wounds (19). Pantoea agglomerans has been reported in septic monoarthritis after plant thorn and wood sliver injuries (17, 20–23). Enterobacter cloacae were cultured from a forearm wound caused by a tree branch particle (24).

    Puncture wounds in children are very common and often result in foreign body retention. Organic materials in the form of plant thorns present problems in identification and localization because they are not visualized with plain radiographs. A case of a 10-year-old girl with a small piece of retained hawthorn is presented. Correct diagnosis and treatment were delayed because of misinterpretation of magnetic resonance image studies. Ultrasound ultimately located the foreign body, and assisted in its excision. Plant thorns may be toxic and produce an intense local inflammatory response. In the case described in this article, deep infection caused by Enterobacter cloacae and Pantoea agglomerans was associated with the retained thorn. The small size of the foreign body, misinterpretation of diagnostic images, and the deep infection highlight the challenges that can be encountered by physicians managing puncture wounds in children.

  • Toothpick injury simulating a pigmented villonodular synovialitis

    2009, Journal of Pediatric Surgery

    Lesions of the bone or the joints as seen in osteomyelitis or monoarthritis are possible [12-15]. Osteolytic lesions of the metatarsalia might even raise the suspicion of a malignant tumor [16-20]. Radiographic assessment might show osseous lesions.

    Injuries to the foot caused by foreign bodies are a frequent cause of local wounds and infections. In most cases, removal of the debris is easy and no comprehensive surgical care is needed.

    This case report is about a patient who stepped on a toothpick 10 years ago. The toothpick penetrated the intermetatarsal region I/II of the patient's right foot without any harm to bone or tendon. Assuming total removal of the toothpick only a partial removal was performed. Eight years after the injury a painless swelling occurred for the first time. The tumor was removed surgically. The histologic workup showed a pigmented villonodular synovitis. In the subsequent year swelling occurred again. Under the impression of recurrent pigmented villonodular synovitis a surgical revision was performed. Surprisingly, an almost completely preserved toothpick surrounded by a distinct reaction of a foreign body granuloma was found.

    In conclusion, foreign-body injuries, as easy as they might seem, need a careful diagnostic workup and sufficient therapy. With injuries documented in medical history, the possibility of a retained foreign body should be considered.

  • An outbreak of Pantoea spp. in a neonatal intensive care unit secondary to contaminated parenteral nutrition

    2005, Journal of Hospital Infection

    (Video) Rose Prick Makes Antelope Woman Seriously Sick

    Contaminated parenteral nutrition (PN) is an important source of infection in neonates. Many organisms have been reported to cause contamination that results in outbreaks in intensive care units. The objective of this study was to investigate an outbreak caused by Pantoea spp., which contaminates PN, in a neonatal intensive care unit (NICU). This was a descriptive study of an outbreak of sepsis in an NICU of a tertiary teaching hospital in Malaysia. Pantoea spp. infection was detected in eight patients over a three-day period from 24 to 27 January 2004 following the administration of PN. Seven of the eight patients died due to the infection. Extensive environmental samplings for culture were performed. PN solution from the NICU and the pharmacy were also cultured during the outbreak period. Pantoea spp. was isolated from blood cultures of all infected patients, and the unused PN from the pharmacy and the NICU. All the strains of Pantoea spp. had a similar antibiotic susceptibility pattern and biochemical reaction. From the results, we concluded that PN was the source of the outbreak and the contamination may have occurred during its preparation in the pharmacy. A thorough investigation has been carried out and, where possible, corrective measures have been taken to avoid similar outbreaks in the future.

  • Foreign-body synovitis mimicking septic arthritis of the knee

    2001, Arthroscopy

    Recurrent synovitis caused by the presence of a foreign body is rare, and a history of trauma in such cases is often absent or unclear. Many foreign substances have been reported to cause synovitis, such as plant thorns,2-11 fragments of wood,12 sea urchin spines,13 needlefish,14 silicone,15 starch,16 fiberglass,17 teeth,18 glass, brick, stone,19 and even a fragment of a tea-cup handle.20 Patients with foreign-body synovitis of the knee present with a clinical picture indistinguishable from septic arthritis.

    Three cases are presented of recurrent synovitis of the knee in children caused by the presence of foreign material. There was no clear history of trauma. Arthroscopy is a useful method providing early diagnosis and simultaneous treatment of this condition.

    Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 993–996

View all citing articles on Scopus

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Copyright © 1991 Published by Elsevier Inc.

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FAQs

How do you treat plant thorn synovitis? ›

Currently, the only treatment for plant thorn arthritis is surgical removal of the thorn fragments and a synovectomy to remove the inflamed joint lining. Without treatment, plant thorn arthritis may develop into chronic arthritis.

Can thorn arthritis heal itself? ›

This arthritis persists until the fragments are removed with a surgical operation. Without surgical resection of the plant fragments, joint inflammation persists and permanent joint destruction can occur. There is no specific medication or home remedy for plant thorn arthritis.

How do you know if you have plant thorn arthritis? ›

The diagnosis of plant thorn arthritis is made by detection of a piece of thorn within the joint by imaging tests or surgical removal and identification of the thorn fragments. The involved joint may be swollen, painful, reddened, stiff, and may have a reduced range of motion.

What is plant thorn synovitis? ›

Plant thorn synovitis, also known as plant thorn arthritis, is a rare and commonly overlooked cause of arthritic disease. This disease is attributed to a granulomatous inflammatory response to retained plant thorn fragments following a puncturing plant thorn injury.

Can you get blood poisoning from a thorn? ›

Leave a thorn or splinter of wood in your body for a few months, and it's likely to disintegrate and further stimulate your body's immune response. And any infection left untreated can spread and cause septicaemia or blood poisoning.

What is the synovitis? ›

Listen to pronunciation. (SIH-noh-VY-tis) Inflammation (swelling, pain, and warmth) of a synovial membrane, which is a layer of connective tissue that lines a joint, such as the hip, knee, ankle, or shoulder. Synovitis is caused by some types of arthritis and other diseases.

Can you get an infection from a thorn? ›

Small objects (splinters) of wood, metal, glass, or plastic can become embedded in the skin. Thorns from roses and other plants also can prick or become stuck in the skin. Splinters can cause an infection if they are not removed.

Can thorns cause pain? ›

Besides being painfully irritating, wood splinters, rose thorns, and other organic prickers left in your body can lead to bacterial or fungal infections.

How do you treat thorn scratches? ›

Treating Skin Irritation
  1. Clean the wound. Wash the skin with mild soap and water right away. ...
  2. Remove any remaining spines or barbs. Use tweezers to remove visible thorns. ...
  3. Ease pain and itching. A simple method to calm irritated skin is to use a cool water compress, says Katta.
Apr 8, 2011

What to do when you get pricked by a thorn? ›

And if you do get pricked by a rose thorn, berry bush or anything else that punctures your skin, always wash with soap and water and cover with a Band-Aid, he said. That advice is echoed by Vanderbilt University's Schaffner. “The lesson for the average person: Enjoy yourself, take care, wear gloves.

How do you treat a thorn in your foot? ›

Remove Larger Splinter

Open the skin and expose enough of the splinter to remove it with tweezers. If you have trouble seeing the splinter, use stronger lighting and a magnifying glass. Clean wound area again. Apply a bandage and antibiotic ointment.

How do you treat a thorn rose injury? ›

Treatment. It's likely your doctor will prescribe a several-month course of antifungal medication, such as itraconazole. If you have a severe form of sporotrichosis, you doctor might start your treatment with an intravenous dose of amphotericin B followed by an antifungal medication for at least a year.

Can rose thorns cause an allergic reaction? ›

Rose-thorn injuries have not been previously reported as a trigger for an acute allergic reaction with angioedema. The thorn on a rose stem provides an excellent device for injecting infectious material into our skin.

How long can a thorn stay in your body? ›

Sometimes the body can naturally expel a splinter from the skin without causing an inflammatory response, Biehler said. Other times, the splinter may stay in the skin forever. Biehler noted that one of his nurse friends has had an inch-long thorn in her hand for the past 40 years.

How do you know if infection is in your bloodstream? ›

Sepsis Symptoms
  1. Fever and chills.
  2. Very low body temperature.
  3. Peeing less than usual.
  4. Fast heartbeat.
  5. Nausea and vomiting.
  6. Diarrhea.
  7. Fatigue or weakness.
  8. Blotchy or discolored skin.
Jun 27, 2020

What are the warning signs of sepsis? ›

The signs and symptoms of sepsis can include a combination of any of the following:
  • confusion or disorientation,
  • shortness of breath,
  • high heart rate,
  • fever, or shivering, or feeling very cold,
  • extreme pain or discomfort, and.
  • clammy or sweaty skin.
Aug 31, 2017

What doctor treats synovitis? ›

Synovitis treatments

Patients who don't respond to these treatments may be referred to an orthopedic surgeon to discuss a synovectomy, a procedure in which much of the synovium is removed.

What diseases cause synovitis? ›

Synovitis Causes

Synovitis is a major problem in rheumatoid arthritis, in juvenile arthritis, in lupus, and in psoriatic arthritis. It may also be associated with rheumatic fever, tuberculosis, trauma, or gout. Rheumatoid arthritis involves synovitis.

How long does synovitis take to heal? ›

Toxic synovitis usually goes away within a week or two, but sometimes can last for 4–5 weeks. While most kids have no long-term effects from it, some can develop toxic synovitis multiple times during childhood. If your child has a history of toxic synovitis, let your doctor know.

What are symptoms and signs of sporotrichosis? ›

Symptoms include cough, shortness of breath, chest pain, and fever. Symptoms of disseminated sporotrichosis depend on the body part affected. For example, infection of the joints can cause joint pain that may be confused with rheumatoid arthritis.

What parasite leaves black specks on skin? ›

Patients with Morgellons disease may shed unusual particles from the skin described as fibers, “sand” or seed-like black specks, or crystallized particles.

What is the best antibiotic for a puncture wound? ›

For deeper contaminated wounds and delayed presentation in high-risk patients, broad-spectrum oral antibiotics are recommended such as amoxicillin/clavulanic acid, trimethoprim/sulfamethoxazole, or clindamycin with ciprofloxacin.

What to do when you get pricked by a thorn? ›

And if you do get pricked by a rose thorn, berry bush or anything else that punctures your skin, always wash with soap and water and cover with a Band-Aid, he said. That advice is echoed by Vanderbilt University's Schaffner. “The lesson for the average person: Enjoy yourself, take care, wear gloves.

What happens when you get poked by a rose thorn? ›

It can cause infection, redness, swelling and open ulcers at the puncture site. The fungus can spread to the lymphatic system and move on to the joints and bones, where it ends up attacking the central nervous system and lungs when the thorn or thorns are deeply embedded.

Can you get an infection from a thorn? ›

Small objects (splinters) of wood, metal, glass, or plastic can become embedded in the skin. Thorns from roses and other plants also can prick or become stuck in the skin. Splinters can cause an infection if they are not removed.

How do you treat thorn scratches? ›

Treating Skin Irritation
  1. Clean the wound. Wash the skin with mild soap and water right away. ...
  2. Remove any remaining spines or barbs. Use tweezers to remove visible thorns. ...
  3. Ease pain and itching. A simple method to calm irritated skin is to use a cool water compress, says Katta.
Apr 8, 2011

What does a thorn infection look like? ›

The progression of symptoms is typically the following: A small and painless pink, red, or purple bump forms where the fungus entered the skin. The bump get bigger and starts to look like an open sore. More bumps or sores might appear in the near vicinity of the original bump.

Can you get blood poisoning from a thorn? ›

Leave a thorn or splinter of wood in your body for a few months, and it's likely to disintegrate and further stimulate your body's immune response. And any infection left untreated can spread and cause septicaemia or blood poisoning.

Can plant thorns be poisonous? ›

ANSWER: In North America there are few plants that have poisonous thorns. The members of the Solanum (nightshade) genus have thorns and are reported to cause injuries that are slow to heal due to poisonous thorns.

Can you get sick from a rose thorn? ›

It can cause infection, redness, swelling and open ulcers at the puncture site. The fungus can spread to the lymphatic system and move on to the joints and bones, where it ends up attacking the central nervous system and lungs when the thorn or thorns are deeply embedded.

Can sporotrichosis be cured? ›

Most cases of sporotrichosis only involve the skin or the tissues underneath the skin. These infections are not life-threatening, but must be treated with prescription antifungal medicine for several months. The most common treatment for this type of sporotrichosis is itraconazole, taken by mouth for 3 to 6 months.

How do you remove a rose thorn under your skin? ›

How to remove a splinter
  1. Wash and dry the area. To prevent infection, wash your hands and the affected area with soap and water and gently pat your skin dry.
  2. Inspect the splinter. ...
  3. Use tweezers to remove the splinter. ...
  4. Use a small needle to remove the splinter. ...
  5. Clean and apply petroleum jelly.

What parasite leaves black specks on skin? ›

Patients with Morgellons disease may shed unusual particles from the skin described as fibers, “sand” or seed-like black specks, or crystallized particles.

What diseases can you get from gardening? ›

Bacteria such as Escherichia coli, Salmonella, Campylobacter jejuni, and Listeria monocytogenes are often present in gardens as a result of using cow, horse, chicken or other animal manure.

What is the best antibiotic for a puncture wound? ›

For deeper contaminated wounds and delayed presentation in high-risk patients, broad-spectrum oral antibiotics are recommended such as amoxicillin/clavulanic acid, trimethoprim/sulfamethoxazole, or clindamycin with ciprofloxacin.

How long can a thorn stay in your body? ›

Sometimes the body can naturally expel a splinter from the skin without causing an inflammatory response, Biehler said. Other times, the splinter may stay in the skin forever. Biehler noted that one of his nurse friends has had an inch-long thorn in her hand for the past 40 years.

Can thorns cause tetanus? ›

Tetanus tends to occur in people following injury. It is caused by Clostridium tetani bacteria (commonly found in soil) that penetrate the skin. Some examples of how this may happen include: a prick from a rose thorn.

Can you be allergic to thorns? ›

Thorn fragment can causes Type 1 hypersensitivity reactions in the form of anaphylaxis, urticaria, and angioedema.

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